Provider Demographics
NPI:1487100681
Name:CAIN, ASHELY NICOLE (BCBA)
Entity type:Individual
Prefix:
First Name:ASHELY
Middle Name:NICOLE
Last Name:CAIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8308
Mailing Address - Country:US
Mailing Address - Phone:678-254-8013
Mailing Address - Fax:
Practice Address - Street 1:1311 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2325
Practice Address - Country:US
Practice Address - Phone:404-422-9190
Practice Address - Fax:866-704-2179
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-24-72973103K00000X, 103K00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor